The use of a diversion tube to reduce blood culture contamination: A "real-life" quality improvement intervention study

• Published in: American journal of infection control Vol. 51; no. 9; pp. 999 - 1003
• Main Authors: Wiener-Well, Yonit, Levin, Phillip D, Assous, Marc V., Algur, Nurit, Barchad, Orit Wolfovitz, Lachish, Tamar, Zalut, Todd, Yinnon, Amos M., Ben-Chetrit, Eli
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2023
• Subjects: Initial specimen diversion; Real-life study; Initial specimen diversion; Real-life study
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2023.02.015

•Diversion of the initial blood specimen is a simple method for reducing blood culture contamination previous randomized controlled studies included small number of patients.•This "real-life" implementation of diversion included >20,000 blood cultures.•Comparing diversion versus nondiversion technique–contamination rate decreased by 31%.•Older patients had higher contamination rate and diversion was less effective. Blood culture contamination is associated with health care costs and potential patient harm. Diversion of the initial blood specimen reduces blood culture contamination. We report results of the "real-life" clinical implementation of this technique. Following an educational campaign, use of a dedicated diversion tube was recommended prior to all blood cultures. Blood culture sets taken from adults using a diversion tube were defined as "diversion sets," those without, "non-diversion" sets. Blood culture contamination and true positive rates were compared for diversion and nondiversion sets and to nondiversion historical controls. A secondary analysis investigated efficacy of diversion by patient age. Out of 20,107 blood culture sets drawn, the diversion group included 12,774 (60.5%) and the nondiversion group 8,333 (39.5%) sets. The historical control group included 32,472 sets. Comparing nondiversion to diversion, contamination decreased by 31% (5.5% [461/8333] to 3.8% [489/12744], P < .0001]. Contamination was also 12% lower in diversion than historical controls [3.8% (489/12744) vs 4.3% (1,396/33,174) P = .02)]. The rate of true bacteremia was similar. In older patients, contamination rate was higher, and the relative reduction associated with diversion decreased (54.3% amongst 20-40-year-olds vs 14.5% amongst >80-year-olds). Use of a diversion tube in the ED reduced blood culture contamination in this large real life observational study. Efficacy decreased with increasing age, which requires further investigation.